Implementation and Evaluation

of a Pharmacist Led DOAC

Management Service
Mallory Carter, PharmD
PGY1 Pharmacy Resident
Saint Joseph Health System

Ed Sheridan, PharmD, MBA, BCPS, BCACP

Ambulatory Care Residency Program Director
Saint Joseph Health System

Neither the presenter nor the mentor has any conflict of interests to disclose.
BACKGROUND: ANTICOAGULATION CLINIC

Saint Joseph Family Medicine Center: pharmacy

resident-run anticoagulation (warfarin) clinic
 BACKGROUND: DIRECT ORAL
ANTICOAGULANTS (DOACs)

DOACs

Sylvester KW, Chen A, Lewin A, Fanikos J, Goldhaber SZ, Connors JM. Optimization of DOAC management services in a centralized anticoagulation clinic. J Thromb Haemost. 2022;6(3).
doi: 10.1002/rth2.12696.
BACKGROUND: CONSIDERATIONS

DOAC Half-Life Renal Dosing? Price Other

Apixaban 8-15 hours Yes $561 Consider indication,

age, weight
Rivaroxaban 5-9 hours Yes $516 Take with food

Dabigatran 12-17 hours Yes $535

Edoxaban 10-14 hours Yes $467

Warfarin 20-60 hours No <$30 Frequent INR

monitoring
 LEARNING CHECKPOINT
What is the list price of a 1-month supply of
apixaban (Eliquis)?
a.$623
b.$561
c.$358
d.$275
 LEARNING CHECKPOINT
Why should rivaroxaban 20mg be taken with
food?
a.To improve GI tolerability
b.To increase the likelihood of adherence
c.To increase the AUC
d.To increase the half-life
 BACKGROUND: THE NEED
• In a study of 26,471 patients with atrial
fibrillation, <50% were adherent to their
DOAC
• Prospective analysis for nonvalvular AFib
found that 49% of patients were
inappropriately prescribed their DOAC

Hache J, Bonsu KO, Chitsike R, Nguyen H, Young S. Assessment of a pharmacist-led direct oral anticoagulant monitoring clinic. Can J Hosp Pharm. 2021;74(1):7-14. PMID: 33487649,
PMCID: PMC7801335.
Sylvester KW, Chen A, Lewin A, Fanikos J, Goldhaber SZ, Connors JM. Optimization of DOAC management services in a centralized anticoagulation clinic. J Thromb Haemost. 2022;6(3). doi:
10.1002/rth2.12696.
 BACKGROUND: PHARMACIST IMPACT
• Interventions
– Medication access/assistance
– Dose adjustments
– Coordinated care procedure plans
• Pharmacist-led DOAC service resulted in significant
differences:
– Appropriate dosing at baseline and follow up
– Medication possession ratio
Sylvester KW, Chen A, Lewin A, Fanikos J, Goldhaber SZ, Connors JM. Optimization of DOAC management services in a centralized anticoagulation clinic. J Thromb Haemost. 2022;6(3).
doi: 10.1002/rth2.12696.
Ashjian E, Kurtz B, Renner E, Yeshe R, Barnes GD. Evaluation of a pharmacist-led outpatient direct oral anticoagulant service. Am J Health Syst Pharm. 2017;74(7):483-489. doi:
10.2146/ajhp151026.
Perlman A, Horwitz E, Hirsh-Raccah B, et. al. Clinical pharmacist led hospital-wide direct oral anticoagulant stewardship program. Isr J Health Policy Res. 2019;8(19). doi: 10.1186/s13584-
019-0285-9.
RESEARCH QUESTIONS
PURPOSE
METHODS
PATIENT INTERVIEW
CRITERIA
ENDPOINTS
 CHARACTERISTICS

Characteristic N=14 (%) Characteristics N = 14 (%)

Age 64.4 Indication
Sex •Atrial Fibrillation 6 (42.8%)
•Male 7 (50%) •Thrombophilia 4 (28.6%)
•Female 7 (50%) •DVT/PE 4 (28.6%)
Race Drug Regimen
•White 10 (71.4%) •Apixaban 2.5mg BID 3 (21.4%)
•Black/African American 4 (28.6%) •Apixaban 5mg BID 7 (50%)
•Rivaroxaban 20mg 4 (28.6%)
RESULTS – PRIMARY ENDPOINT
RESULTS – SECONDARY
ENDPOINTS
 ADDITIONAL FINDING

Pharmacist intervention made in

92.9% of patients.
PHARMACIST INTERVENTIONS
STRENGTHS AND LIMITATIONS
 CONCLUSION
• Pharmacist made an intervention in 92.9% of
patients
• Need for patient education upon initiation of
DOAC therapy
• Future
– Incorporation into existing anticoagulation clinic
– Stratify follow up period
– Expansion
 REFERENCES
• Ashjian E, Kurtz B, Renner E, Yeshe R, Barnes GD. Evaluation of a pharmacist-led
outpatient direct oral anticoagulant service. Am J Health Syst Pharm.
2017;74(7):483-489. doi: 10.2146/ajhp151026.
• Hache J, Bonsu KO, Chitsike R, Nguyen H, Young S. Assessment of a pharmacist-led
direct oral anticoagulant monitoring clinic. Can J Hosp Pharm. 2021;74(1):7-14.
PMID: 33487649, PMCID: PMC7801335.
• Perlman A, Horwitz E, Hirsh-Raccah B, et. al. Clinical pharmacist led hospital-wide
direct oral anticoagulant stewardship program. Isr J Health Policy Res. 2019;8(19).
doi: 10.1186/s13584-019-0285-9.
• Sylvester KW, Chen A, Lewin A, Fanikos J, Goldhaber SZ, Connors JM. Optimization
of DOAC management services in a centralized anticoagulation clinic. J Thromb
Haemost. 2022;6(3). doi: 10.1002/rth2.12696.
Implementation and Evaluation
of a Pharmacist Led DOAC
Management Service

Mallory Carter, PharmD

Ambulatory Care PGY1 Pharmacy Resident
Saint Joseph Health System

Ed Sheridan, PharmD, MBA, BCPS, BCACP

Ambulatory Care Residency Program Director